Hurry up and wait!

It appears we will be in this holding pattern for maybe the next couple of months until Loraine has healed from her mastectomy enough to begin her radiation treatments. She has had a set back with a deep infection to her incision that was discovered by the wound care specialist that Dr. Butler had referred her to a few weeks back. For all intents and purposes, Loraine’s healing appeared to be coming along fine, there was some dead skin at the incision site, but that was not unexpected and did not look abnormal to either the surgical or medical oncologists that had been seeing her. Dr. Butler, the surgical oncologist thought it would be a good idea to have some of the dead flesh removed by the wound care specialist, Dr. Matson, solely as a precautionary measure to facilitate a speedier healing process. There were no indications of a deep infection from the outside when Loraine went to see Dr. Matson, therefore it was quite the surprise to find out there was actually a very significant infection brewing under the surface within the deep tissues. Visually, there was no indication of redness, swelling, pus or any type of foul smelling discharges from her incisions. We had thought radiation treatments would be able to be started within the next couple of weeks. It is just another thing learned when dealing with breast cancer I guess..

It has been about 4 weeks ago that Dr. Butler prescribed Loraine Silvadene which is a cream that is supposed to help prevent and treat wound infections. She prescribed this solely as a preventive measure as there were no indications of infections in Loraine’s incisions. We applied this cream daily after Loraine’s showers before applying new bandages over the incisions. It turns out that Silvadene is not a medicated cream that Dr. Matson thinks should be used on these types of wounds as according to him, it inhibits the healing process instead of helping it along. When Dr. Matson cut away the dead skin from Loraine’s incision, there was a very foul smell and a bunch of pus lying underneath. He told Loraine to quit using the Silvadene and to now use SilvaSorb on the site instead. He told Loraine that he wished doctors would not prescribe the use of Silvadene on these types of wounds as it slows healing. I only bring this up, not because I think Dr. Butler was wrong in prescribing the Silvadene in the first place, but to give you information to bear in mind should you ever be presented the same situation. You might want to inquire whether the doctor means one or the other, since the names are so similar and the the two medications are both silver based and do similar jobs. Breast cancer, or any type cancer for that matter, is a great learning experience as you will be faced with so many unknowns. While we always knew infection was a possibility, we did not expect the extent of this one Loraine has been hit with. Dealing with this type of thing is not for the timid or those with a weak stomach. Whether you are prepared or not, these types of things just have to be dealt with in the home.

I have to admit, the first dressing change after the dead skin from Loraine’s incision was cut away revealing the infection was tough. There is a hole that you could fit a quarter into that is at least one fourth of an inch deep. The underlying muscle tissue is exposed along with fatty tissue and pus which must be cleaned out with sterile saline solution before applying SilvaSorb ointment and new bandages. I do not have difficulties in seeing sights like this on others, yet seeing it on the love of my life was quite hard. Changing these dressings and nursing the wounds is not a job for the squeamish at all. Once I clean out the pus, I find myself scared to death of causing Loraine any type of pain as I spread the SilvaSorb into that deep pit. Loraine has dealt with serious infections and bedsores in her work as a home health care attendant, but this was too much for her to bear looking at. Therefore, nightly dressing changes has been my job before leaving to work in the evenings. I can’t blame her one bit.

Today’s visit with the wound care doctor.

I took Loraine to see Dr. Matson this morning to have the wound looked at. The doctor took measurements and pictures which were entered into her records and compared with last weeks. Fortunately, the wound is a little smaller yet still has a long way to go before being fully healed enough for her to begin radiation treatments. After  the measurements and pictures were taken, he then cut away dead fatty tissue and debrided the wound. Thankfully, they used a good numbing gel and Loraine does not have full feeling there yet, It looked painful. And then, smart guy me, I just had to stand where I could watch and did not notice that I was standing on the seat controls that raise, lower and leans the seat. I felt like a real goober when the doctor looked at me and told me I was standing on the control. I was so enthralled with watching the procedure that I did not notice the seat was rising as he was trying to work on her. He was friendly enough, but I know it probably had to chap his ass this happened. I know it would mine. Lesson learned is to keep my ass back. Once he was through with debriding the wound, the nurse packed it with a new medicine that he wants her to use instead of the SilvaSorb. This looks kind of like a bandage except it dissolves when in the wound. It is a collagen and silver based medicine. I hope we see more healing next week, the week after and after…

Most women do not get infections after mastectomy.

From BreastCancer.org

• More than 1 in 20 women (a little higher than 5%) developed an infection at the site of the incision after breast surgery.
• The risk of infection was different depending on the type of surgery that was being done:
  • 4% for mastectomy with no reconstruction
  • 12% for surgery with implant reconstruction
  • 7% for reconstruction surgery using skin and/or muscle from the belly area
  • 1% for breast reduction surgery

When you are preparing yourself for a surgical procedure, odds are you are only thinking of getting fixed, or getting your diseased parts removed from your body. There is an overwhelming amount of emotions that will flood your mind when dealing with breast cancer, it is almost impossible to think of everything you might need to ask the doctors involved in your care team. If surgery is a part of your treatment for breast cancer and you’re concerned about the possibility of infection, talk to your doctor about:

• How often infections occur after the type of surgery you’re having in the hospital you’ll be using.
• How that infection rate compares to the infection rate at other area hospitals.
• The possibility of your surgery being done as an outpatient procedure or with a short hospital stay after surgery. Many infections after surgery happen because of germs in the hospital environment.
• The steps that will be taken before, during, and after surgery to reduce the risk of infection. For example, some doctors recommend that people scheduled for surgery use a special washing procedure before coming to the hospital. Other doctors may prescribe antibiotics before or during surgery to lower the risk of infection.

It’s important to remember that most women having breast surgery will NOT develop an infection. If an infection does develop, it usually can be treated successfully with antibiotics. Together, you and your doctor can develop a plan that is the best for YOU.